We read with interest the letter of Cantagallo and Castelli(1), which describes the prevalence of asymptomatic bacteriuria (ASB) in women with diabetes before and after hygiene modifications. They showed that even after the modification of hygiene habits, diabetic women still had a 20.2% prevalence of ASB, which is comparable with the prevalence of ASB in our study group of diabetic women,but much higher than the prevalence of ASB in our nondiabetic control subjects(2). We would like to know why ASB was treated in these patients and how long they remained free from bacteriuria. In contrast to patients in the U.S.(3), most diabetic patients with ASB in Europe are not treated(4). Furthermore, many patients(with and without diabetes) have recurrent bacteriuria despite treatment(5,6). The contradiction in treatment recommendations between the U.S. and Europe is the result of a lack of follow-up studies of diabetic women with untreated ASB. In a long-term follow-up study of our diabetic patients, we hope to discover whether ASB affects renal function and whether treatment can prevent this.
Cantagallo and Castelli (1)underline specific hygiene habits that can help prevent ASB and urinary tract infections (UTIs). General measurements to prevent ASB and UTIs were previously described for all patients, including nondiabetic patients(7). Nevertheless, the authors are correct that most studies show results of trials with different antimicrobial treatment regimens and do not describe simple cost-free ways to prevent bacteriuria. Therefore, the study described in the letter by Cantagallo and Castelli (1) is a welcome addition to the research on ASB and UTIs in diabetic women.
A.I.M.H. has served on an advisory panel of Pfizer.
